The management of revenue cycle processes – including billing and reimbursements – can be time- consuming and complex for a healthcare organization. Challenges include understanding and managing all reimbursement rules, regulations, and payor-specific variables in addition to tracking down the required supporting clinical details from within the organization which may prove difficult as well.
Using Our System users will be able to easily create, manage and validate their claims with a couple of simple steps, and / or use one of the bulk actions to processes more than one claim at the same time without risking their quality thanks to its validation engine and workflow.
Highlighted Features:
Claim processing: Our System will allow the medical coders to review claims, justify them, and make sure that they are meeting the coding rules and guidelines in a very simple and efficient user interface.
The users can easily track changes on an individual claim and validate it through the validation engine ensuring that it is technically correct and is following the providers internal and contractual rules and guidelines.
Online Claim Verification: To help reduce rejections, Our System will allow users to submit the claims for online testing, report errors for each claim, and help users to fix the errors before actual submission.
Work Force Management: Our System is designed with the needed process and activities to maintain productive workforce, it helps supervisors and team leaders plan work responsibilities and duties, by matching employee skills to specific tasks over time, design team and work queues, and tracking results of the work efforts.
Claim Submission and Batch Management: Our System support both individual claim submission as well as batch submissions, in both cases the users are not allowed to submit any unvalidated and approved claims, upon completing the submission claims change their status in Our System to prevent any changes ensuring the integrity of the data until Remittances advises are posted. The system will notify the users upon a successful submission and will provide summaries for each.
Manual Remit utility: is an embedded utility within Our System RCM designed to be used by team leaders and supervisors to correct any invalid posted remittances by the payers, the users can easily remap the claim with the corrected RA file and or use an external file to correct it.
Denial Management:upon usefully mapping the remittance to a claim the system will capture denials and helps the user in analysing trends and identifying key issues that resulted in these denials and clearly displaying the associated denial reason descriptions and codes, this will help make informed, knowledgeable actions within those rejected areas all while maintaining the full history of the claim in all its previous iterations both record and price wise.
